Provider Demographics
NPI:1891965802
Name:HERNANDEZ LORING, JOSE MANUEL (DMD MPH MS)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:MANUEL
Last Name:HERNANDEZ LORING
Suffix:
Gender:M
Credentials:DMD MPH MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 361916
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-1916
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:65 INF AVE KIM 14.7
Practice Address - Street 2:LOS COLOBOS SH CTER CINEMA BUILD SUITE 201
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-776-0814
Practice Address - Fax:787-776-0805
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9881223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics